Provider Demographics
NPI:1356404610
Name:MCCLURE FLOYD, DALE R (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DALE
Middle Name:R
Last Name:MCCLURE FLOYD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 HAWTHORNE PARK
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2164
Practice Address - Country:US
Practice Address - Phone:706-310-9241
Practice Address - Fax:706-310-9276
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA372422808AMedicaid
GA52991515 001OtherBCBS PROVIDER
GA7097852OtherAETNA PROVIDER
GA519782337AMedicaid